IAJPS 2017, 4 (07), 1908-1913 Suhail Ahmed Almani et al ISSN 2349-7750

CODEN [USA]: IAJPBB ISSN: 2349-7750

INDO AMERICAN JOURNAL OF

PHARMACEU TICAL SCIENCES
http://doi.org/10.5281/zenodo.826975

Available online at: http://www.iajps.com Research Article

SERUM ADENOSINE DEAMINASE LEVEL IN PATIENTS

WITH TYPE 2 DIABETES MELLITUS
Dr. Suhail Ahmed Almani1*, Dr. Tariq Zaffar Shaikh1, Dr. Muhammad Iqbal1,
Dr. Abdul Subhan Talpur1, Dr. Sumera Bukhari2, Dr. Zulfiqar Ali Qutrio Baloch3
1
Department of Medicine, Liaquat University of Medical and Health Sciences (LUMHS)
Jamshoro.
2
St. Francis Medical Center, Trenton, New Jersey.
3
Brandon Regional Hospital, Brandon, Florida, U.S.A.
Abstract:
Objective: to evaluate the serum adenosine deaminase level in patients with type 2 diabetes mellitus at tertiary care
hospital Hyderabad.
Patients and Methods: This six month cross sectional descriptive study was conducted in the department of
medicine at tertiary care hospital Hyderabad. The inclusion criteria of this cross sectional study (six months
duration) were the individuals with uncomplicated type 2 diabetes mellitus had 35 years of age and both male and
female gender. The study diabetic population was screened for serum adenosine deaminase level by taking 2 cc
venous blood sample and sent to laboratory for analysis. The frequency and percentages was calculated while the
mean SD was computed for numerical variables.
Results: Total fifty type 2 diabetic individuals were studied during six months study period, the mean age SD for
whole population was 52.878.85 while mean SD for fasting and random blood glucose and HBA1C was
131.214.82 and 230.639.94 and 10.722.43 respectively. The male population was predominant 35 (70%) while
the serum ADA was raised in 29 (58%) type 2 diabetic populations and also correlates with HBA1C 23 (79.3%)
Conclusion: serum ADA levels play an important role in evaluating the glycemic status and an indicator in the
immuno-pathogenesis of diabetes mellitus.
Keywords: Diabetes mellitus, adenosine deaminase and Metabolism
Corresponding author:
Dr. Suhail Ahmed Almani, QR code
Department of Medicine,
Liaquat University of Medical and Health Sciences (LUMHS)
Jamshoro.
Email: zulfikar229@hotmail.com

Please cite this article in press as Suhail Ahmed Almani et al, Serum Adenosine Deaminase Level in Patients with
Type 2 Diabetes Mellitus, Indo Am. J. P. Sci, 2017; 4(07).

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 IAJPS 2017, 4 (07), 1908-1913 Suhail Ahmed Almani et al
INTRODUCTION:
The prevalence of type 2 diabetes mellitus and
obesity is increasing rapidly and has been reported
that approximately 2.3 billion people will be
overweight and more than 700 million people obese
worldwide. [1, 2] Type 2 diabetes mellitus has two
facets, the insulin resistance and malfunction of -
cells of pancreas [3]
Adenosine deaminase (ADA) is an enzyme involved
in the metabolism of purine nucleosides catalyses the
irreversible hydrolytic deamination of adenosine
(Ado) and 2-deoxyadenosine (2-dAdo) to inosine
and 2-deoxyinosine, respectively. [4] Former studies
shown that ADA reduces adenosine levels, increases
basal and lipolysis in adipocytes stimulated by
noradrenaline. [5, 6] Several studies have found
elevated levels of adenosine deaminase in subjects
with type 2 diabetes mellitus but the exact
pathogenesis is unknown and should be explored
whereas the insulin administration has been shown to
reduce the ADA levels in type 2 diabetic population.
[7-9] Adenosine has multiple effects and acts through
its receptors following its release affects different
tissue and organ functions including skeletal muscle,
pancreas, hepatic, renal and cardiovascular vascular
tissues. The expression level of adenosine nucleoside
transporters and adenosine receptors has been shown
to be different in diabetes. [10, 11] Chronic energy
imbalance leads to hypertrophy and hyperplasia of
adipocyte, stress for endoplasmic reticulum and
dysfunction of mitochondria. In reaction the
adipocytes produce huge amounts of inflammatory
cytokines that impaired the immune cells exist in
close proximity of the macrophages and adipocytes,
such inflammation is also associated with insulin
resistance in diabetes mellitus.[12] Adenosine is also
acts as endogenous regulator of various functions in
the immune system, thus the adenosine receptors are
also important for drug targets in the adipose tissue to
reduce the underlying inflammation in obesity and
increase insulin sensitivity.
Therefore the present study was hospital based cross
sectional study wherein the adenosine deaminase was
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ISSN 2349-7750
measured in diabetic populations and helped
ascertain the existence of correlation between serum
ADA and blood sugar level.
PATIENTS AND METHODS:
The inclusion criteria of this cross sectional study
(six months duration) were the individuals with
uncomplicated type 2 diabetes mellitus had 35 years
of age and both male as well as female gender while
the exclusion criteria of the study were subjects with
diabetic complications neuropathy, nephropathy,
retinopathy and vascular complications, acute or
chronic infection and pregnant and lactating ladies
were excluded from the study. All the relevant
individuals were stratified and after taking the
informed consent the subjects were enrolled and
recruited in the study. The history was taken,
examination was performed and the routine
investigations were advised. The study diabetic
population was screened for serum adenosine
deaminase level by taking 2 cc venous blood sample
and sent to laboratory for analysis. The normal
adenosine deaminase level is 30 U/L and the value
> 30 U/L was considered as raised / high. The data
was collected on pre-designed proforma and analyzed
in SPSS version 16. The frequency and percentages
(%) was computed and the numerical variables were
presented as mean SD. The chi-square test was
used to compute the categorical variables with p-
value 0.05 as statistical significance.
RESULTS:
Total fifty type 2 diabetic individuals were studied
during six months study period, the mean age SD
for whole population was 52.878.85 while mean
SD for fasting and random blood glucose and
HBA1C was 131.214.82 and 230.639.94 and
10.722.43 respectively. The male population was
predominant 35 (70%) while the serum ADA was
raised in 29 (58%) type 2 diabetic populations. The
results of the study are presented in Table 1-7.
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 IAJPS 2017, 4 (07), 1908-1913 Suhail Ahmed Almani et al ISSN 2349-7750

Table 1: The Demographical and Clinical Data of the Study Population

AGE (yrs) FREQUENCY (n=50) PERCENTAGES (%)

35-39 10 20
40-49 12 24
50-59 10 20
60-69 15 30
70+ 03 06

GENDER
Male 35 70
Female 15 39

BMI (kg/m2)
19-25 18 36
25-30 20 40
>30 12 24

DURATION OF DIABETES (yrs)

<1 07 14
1-5 14 28
5-10 20 40
>10 09 18

Table 2: The Age and Gender Distribution

GENDER Total
AGE (yrs) Male Female
35-39 6 4 10
17.1% 26.7% 20.0%
40-49 9 3 12
25.7% 20.0% 24.0%
50-59 8 2 10
22.9% 13.3% 20.0%
60-69 10 5 15
28.6% 33.3% 30.0%
70+ 2 1 3
5.7% 6.7% 6.0%
Total 35 15 50
100.0% 100.0% 100.0%

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 IAJPS 2017, 4 (07), 1908-1913 Suhail Ahmed Almani et al ISSN 2349-7750

Table 3: The Age Distribution In Relation To HBA1C

HEMOGLOBIN A1C Total

AGE (yrs) Raised Normal
35-39 9 1 10
30.0% 5.0% 20.0%
40-49 4 8 12
13.3% 40.0% 24.0%
50-59 7 3 10
23.3% 15.0% 20.0%
60-69 9 6 15
30.0% 30.0% 30.0%
70+ 1 2 3
3.3% 10.0% 6.0%
Total 30 20 50
100.0% 100.0% 100.0%
*p-value = 0.05; statistically significant

Table 4: The Age Distribution In Relation To Adenosine Deaminase

SERUM ADENOSINE DEAMINASE Total
AGE (yrs) Raised Normal
35-39 9 1 10
31.0% 4.8% 20.0%
40-49 5 7 12
17.2% 33.3% 24.0%
50-59 4 6 10
13.8% 28.6% 20.0%
60-69 10 5 15
34.5% 23.8% 30.0%
70+ 1 2 3
3.4% 9.5% 6.0%
Total 29 21 50
100.0% 100.0% 100.0%
*p-value: 0.04; statistically significant
Table 5: The Gender In Relation To Glycated Hemoglobin
HEMOGLOBIN A1C Total
GENDER raised Normal
Male 24 11 35
80.0% 55.0% 70.0%
Female 6 9 15
20.0% 45.0% 30.0%
Total 30 20 50
100.0% 100.0% 100.0%
*p=0.05; significant

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 IAJPS 2017, 4 (07), 1908-1913 Suhail Ahmed Almani et al ISSN 2349-7750

Table 6: The Gender and Adenosine Deaminase Level

SERUM ADENOSINE DEAMINASE Total

GENDER Raised Normal
Male 21 14 35
72.4% 66.7% 70.0%
Female 8 7 15
27.6% 33.3% 30.0%
Total 29 21 50
100.0% 100.0% 100.0%
*p-value: 0.66; statistically non-significant

Table 7: The Glycated Hemoglobin In Relation To Adenosine Deaminase

SERUM ADENOSINE DEAMINASE Total

HBA1C Raised
Raised 23
79.3%
Normal 6 14
20.7%
Total 29
100.0%
*p-value: 0.001; statistically significant
DISCUSSION:
The diabetes mellitus is a common disorder
characterized by increase blood glucose due to
variable interaction of environmental and hereditary
factors along with of insulin resistance leads to long
term complications with devastating consequences.
The present study observed elevated serum adenosine
deaminase (ADA) level in subjects with type 2
diabetes mellitus consistent with the former several
studies. [13, 14] In addition former literature
observed that the serum ADA levels back to
normalize after insulin infusion [15], although the
pharmacological activity of insulin treatment on
serum ADA levels not evaluated in the present study.
In present study the positive correlation was
identified between the blood glucose level and serum
ADA level and also detected the positive associations
between the long term index of glycemic control via
glycated haemoglobin (HbA1c) and serum ADA and
consistent with the previous studies. [16, 17] This
positive correlation between glycemic status and
ADA level suggest its major role in carbohydrate and
fat metabolic derangements observed in diabetic
individuals and the finding was also reported by
former studies. [18, 19] The pathogenesis of
increased ADA levels in Type 2 DM is due to extra
cellular Cyclic AMP adenosine pathway. ADA
inhibits adenosine and leads to lipolysis and causes
Normal
7 30
33.3% 60.0%
20
66.7% 40.0%
21 50
100.0% 100.0%
accumulation of Cyclic AMP accumulation. During
insulin deficiency glucose and lipids spread through
blood and are taken by liver, pancreas and adipose
tissue which stores triglycerides leads to hypertrophy
of adipocyte. This in turn causes cellular dysfunction,
elevated free fatty acids and a pro-inflammatory
state. The hepatocytes exposure to excusive glucose
and fat causes insulin resistance and steatohepatitis
worsening the insulin resistence and -cell
dysfunction.[20, 21] The chronic hyperglycemia
causes increase in oxidative stress by producing free
radicals and increases ADA levels further leads to
Insulin resistance. Another mechanism of insulin
resistance is down regulation of GLUT4 receptors
due to deficiency of adenosine. Several studies
observed the elevated serum adenosine deaminase
activity in diabetes mellitus but the exact mechanism
yet to be explored. [22-24] Furthermore serum
adenosine deaminase level and its correlation with
the insulin activity and the glucose tolerance test
should be conducted to strengthen the concept and to
evaluate its role as a prognostic and pathological
marker in type 2 diabetes mellitus.
CONCLUSION: The study observed that increase
HbA1c and blood sugar levels, serum ADA levels
also increased shown its important role in evaluating
the glycemic status and a indicator in the immuno-

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 IAJPS 2017, 4 (07), 1908-1913 Suhail Ahmed Almani et al
pathogenesis of diabetes mellitus suggests that ADA
plays a vital role in the pathophysiology of type 2
DM and its complications, although Further advance
studies are needed to support these observations.
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